ArticleJournal of the American College of Surgeons2016
Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery.
Article in Journal of the American College of Surgeons, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
40 citing papers in PubMed, 1 synthesis or guideline pooled it, 85 citations in OpenAlex.
- Patient Outcomes Following Interhospital Care Fragmentation: A Systematic Review.Journal of general internal medicine · 2020Pooled it
- Divided care, diminished outcomes? The impact of care fragmentation on survival in glioblastoma.Journal of neuro-oncology · 2026Article
- Care Fragmentation following Upper Gastrointestinal and Hepatopancreatobiliary Cancer Surgery: Consequences for Patients and Healthcare Systems.Annals of surgical oncology · 2026Article
- Patterns and Consequences of Care Fragmentation in Post-Surgical Management of Upper Gastrointestinal and Hepatopancreatobiliary Cancers.Annals of surgical oncology · 2026Article
- Factors Associated With Readmission to Index vs. Non-Index Hospitals After Major Cancer Surgery.Cancer medicine · 2025Article
- Fragmentation of Multimodal Rectal Cancer Care: A Population-Level Retrospective Cohort Study.Journal of surgical oncology · 2025Article
- Data-driven insights into interhospital care fragmentation: Implications for health policy and equity among older adults.PloS one · 2025Article
- Geographic distance to Commission on Cancer-accredited and nonaccredited hospitals in the United States.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Factors influencing readmission patterns following radical cystectomy: An analysis of social determinants and discharge outcomes.Urologic oncology · 2024Article
- Fragmented Readmissions From a Nursing Facility in Medicare Beneficiaries.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2024Article
- Care fragmentation and readmission mortality and length of stay before and during the COVID-19 pandemic: data from the National Readmissions Database, 2018-2020.BMC health services research · 2024Observational
- Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2024Article
- Assessment of a collaborative treatment model for trimodal management of esophageal cancer.Journal of thoracic disease · 2023Article
- Influence of the centralizing gastric cancer surgery on the health-related quality of life in Brazil.Journal of gastrointestinal oncology · 2023Article
- Association of Fragmented Readmissions and Electronic Information Sharing With Discharge Destination Among Older Adults.JAMA network open · 2023Article
- Ambulance use and subsequent fragmented hospital readmission among older adults.Journal of the American Geriatrics Society · 2023Article
- The Influence of Rural Healthcare Systems and Communities on Surgery and Recovery: A Qualitative Study.The Journal of surgical research · 2023Article
- Assessment of short readmissions following elective pulmonary lobectomy.American journal of surgery · 2023Article
- Is Fragmented Cancer Care Associated With Medical Expenditure? Nationwide Evidence From Patients With Lung Cancer Using National Insurance Claim Data.International journal of public health · 2023Article
- Association of distance between hospitals and volume of shared admissions.BMC health services research · 2022Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundDespite national emphasis on care coordination, little is known about how fragmentation affects cancer surgery outcomes. Our study examines a specific form of fragmentation in post-discharge care-readmission to a hospital different from the location of the operation-and evaluates its causes and consequences among patients readmitted after major cancer surgery. STUDY
designWe used the State Inpatient Database of California (2004 to 2011) to identify patients who had major cancer surgery and their subsequent readmissions. Logistic models were used to examine correlates of non-index readmissions and to assess associations between location of readmission and outcomes, measured by in-hospital mortality and repeated readmission.
resultsOf 9,233 readmissions within 30 days of discharge after major cancer surgery, 20.0% occurred in non-index hospitals. Non-index readmissions were associated with emergency readmission (odds ratio [OR] = 2.63; 95% CI, 2.26-3.06), rural residence (OR = 1.81; 95% CI, 1.61-2.04), and extensive procedures (eg hepatectomy vs proctectomy; OR = 2.77; CI, 2.08-3.70). Mortality was higher during non-index readmissions than index readmissions independent of patient, procedure, and hospital factors (OR = 1.31; 95% CI, 1.03-1.66), but was mitigated by adjusting for conditions present at readmission (OR = 1.24; 95% CI, 0.98-1.58). Non-index readmission predicted higher odds of repeated readmission within 60 days of discharge from the first readmission (OR = 1.16; 95% CI, 1.02-1.32), independent of all covariates.
conclusionsNon-index readmissions constitute a substantial proportion of all readmissions after major cancer surgery. They are associated with more repeated readmissions and can be caused by severe surgical complications and increased travel burden. Overcoming disadvantages of non-index readmissions represents an opportunity to improve outcomes for patients having major cancer surgery.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.